Case Manager Continuing Care Specialist

1 week ago


Downey, California, United States Kaiser Permanente Full time

strongJobSummary:/strongpAsaCaseManagerContinuingCareSpecialistatKaiserPermanente,youwillplayavitalroleincoordinatingpatientcareandpopulation-basedmanagementforpatientsindefinedgeriatricorotherpatientpopulations.Yourcomprehensiveapproachwillinvolveworkingwithphysicians,staff,andnon-Kaiserproviderstoplanandimplementtreatmentplans,managehealthconditions,andoptimizeresourceutilization./ppInthisrole,youwilldeveloptreatmentplans,monitorcare,andmakerecommendationsforalternativelevelsofcare.Youwillalsoidentifycost-effectiveprotocolsandcarepaths,anddevelopguidelinesforcarethatrequirecoordinationacrosssystemsofmultipleprovidersandservices./ppstrongKeyResponsibilities:/strong/pulliPlan,develop,assess,andevaluatecareprovidedtomembers./liliEvaluateanddevelopbaselinemedicalandpsychosocialevaluationsandindividualizedpatientcare/treatmentplansinconjunctionwithprimarycareandspecialistphysicians./liliRecommendalternativelevelsofcareandensurecompliancewithfederal,state,andlocalrequirements./liliMakeassessmentsofphysiologicalandfunctionalstatusutilizingprotocols./liliInitiateappropriatediagnostictesting/screeningandinterventions./liliDevelopindividualizedpatient/familyeducationplansfocusedonself-managementanddeliverpatient/familyeducationspecifictoadiseasestate./liliImplementstrategiestotarget/assessriskfactorsandachieveandensurepatientfollow-upaccordingtoclinicalandstrategicmeasures/outcomes./liliProducepopulation-basedreportsonoutcomesspecifictodefinedpatientpopulations./liliParticipatewithhealthcareteams/providersinactualizingoutcomesbyplanning,evaluating,andimplementingdecisionsandstrategiestoachievepredeterminedcost,clinical,quality,utilization,andserviceoutcomes./liliDevelopandmaintaincasemanagementpoliciesandprocedures./liliCoordinatecare/serviceswithutilizationand/orqualityreviewersandmonitorlevelandqualityofcare./liliCoordinatetheinterdisciplinaryapproachtoprovidingcontinuityofcare,includingutilizationmanagement,transfercoordination,dischargeplanning,andobtainingallauthorizations/approvals/transfersasneededforoutsideservicesforpatients/families./liliConsultwithinternalandexternalphysicians,healthcareproviders,dischargeplanning,andoutsideagenciesregardingcontinuedcare/treatmentorhospitalizationorreferraltosupportservicesorplacement./liliArrangeandmonitorfollow-upappointments./liliEncouragememberstofollowprescribedcoursesofcare(e.g.,drugtherapy,physicaltherapy)./liliMakereferralstoappropriatecommunityservicesandoutsideproviders./liliIdentifyandrecommendopportunitiesforcostsavingsandimprovingthequalityofcareacrossthecontinuum./liliDevelopandcollectdata;trendutilizationofhealthcareresources./liliInterpretregulations,healthplanbenefits,policies,andproceduresformembers,physicians,medicalofficestaff,contractproviders,andoutsideagencies./liliCoordinatetransmissionofclinicalandbenefittreatmenttopatients,families,andoutsideagencies./liliActasliaisonforoutsideagencies,non-planfacilities,andoutsideproviders./liliCoordinaterepatriationofpatientsandmonitortheirqualityofcare./li/ulpstrongRequirements:/strong/pulliGraduateofanacademicinstitutionaccreditedbytheCouncilonSocialWorkEducationandaMaster'sdegreeinSocialWork./liliDemonstratedknowledgeofcasemanagement,dischargeplanning,transfercoordination;TJCandotherfederal/state/localregulations./liliAbilitytoworkinaLabor/ManagementPartnershipenvironment./li/ulpstrongPreferredQualifications:/strong/pulliMinimumtwo(2)yearsofcasemanagementexperiencewiththepopulationtobecasemanaged./liliCurrentandvalidLCSWhighlypreferred./liliKnowledgeofpsychiatricdiagnoses/treatmentforchildren,adolescents,andadults./li/ul



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